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RESEARCH PAPER ON
HIV/AIDS IN THAILAND AND ITS PREVENTION
COURSE: BIOENGINEERING AND ENVIRONMENTAL HEALTH
Submitted by:
Mr. Md. Matiar Rahaman
ID No. WWF008528
HIV/AIDS IN THAILAND AND ITS PREVENTION
1 Introduction
HIV disease is a continuum of progressive damage to the immune system from the time of
infection to the manifestation of severe immunological damage by opportunistic infection,
neoplasm wasting or low CD4 lymphocyte count that define AIDS. HIV attacks white blood cells
called CD4 positive T-cells and with less efficiency macrophages and neurones. T-cells are the
component of immune system that are able to fight off diseases like tuberculosis, parasitic
infections, fungal infections and infections by viruses. These immune cells also prevent certain
cancers such as Kaposi’s sarcoma, non Hodgkins lymphoma, Burkitts lymphoma and primary
malignancies of the brain. The virus interacts with the T-cell and causes the death of the cell
though the mechanism is not known. The normal level of CD4 cell is about 1200 cells per l. Due
to HIV infection the CD4 cells become less than 400 cells per l.
2. Background Information
In 1981 Gottlieb reported six cases of pneumocystics pneumonia in homosexual men and
suggested a new disease called AIDS. The clinical entity was identified in 1981. AIDS is one of
the 15 killer diseases in the world. UNAIDS and WHO estimate that there were more than 33
millions of people infected with HIV at the beginning of 1998. 40 millions are expected to be
infected in the world by the year 2000. About 11.7 millions patients have already died from the
disease at the beginning of 1998. Despite prevention efforts the virus is spreading causing nearly
16,000 new cases daily throughout the world. AIDS has already left 8.2 millions children without
a mother or both parents. The number is expected to reach 13 millions by the year 2000. Very
few of the children will leave to see their fifth birth day. More than 90% of the HIV positive
people in the world live in an area where there is no access to affordable of available various HIV
therapy and as a result HIV is spreading day by day. Various available therapies slow the
development of the acquired immunodeficiency syndrome. The global HIV/AIDS epidemic
report is shown in Table 1.
Table 1. Global HIV/AIDS epidemic report – June 2000.
Description
People newly infected
with HIV/1999
Number of people
living with HIV/AIDS
AIDS death in 1999
Total number of AIDS
death since epidemic
Total AIDS orphans
Total
(million)
5.4
Adult
(million)
4.7
Women
(million)
2.3
Children <15
years (million)
0.62
34.3
33.0
15.7
1.3
2.8
18.8
2.3
15.0
1.2
7.7
0.5
3.8
13.2
-
-
-
3. Causative agents
In 1984 scientist in the USA and France identified the Human Immunodeficiency Virus (HIV) as
causative agents of AIDS. HIV is a retrovirus, member of the family of primate lentivirus. Two
types of HIV type HIV-1 is responsible for most of the cases of disease worldwise. Type HIV-2
is a serious concern in sub-saharan Africa and is spreading in Asia. In Thailand the virus sub Btype exists but most infected people have sub-type E.
4. Incubation period
The period from HIV infection to development of AIDS is known as the incubation period. The
period varies from <1 year to 20 years. The estimate also varies with the age. In case of young
adult is 10 years and for infant and old adults varies between infection at the age 20 to 40 years.
5. AIDS survival time
The time from first diagnosis of AIDS to death has been studied separately as AIDS survival
time.
6. Present situation of HIV in Thailand
Thailand is in the third position with respect to HIV infection throughout the world. HIV started
in September 1984 in Thailand. The total population of Thailand is about 62 millions in the year
1999. Now the total HIV patients in Thailand are about one million. Total AIDS patients in
Thailand are about 142,207 up to April 2000. The total number of patients that of AIDS patients
died up to April 2000 is 39,193. The approximate number of HIV patients by the year 2000 is
about 1,028,000 and approximate number of AIDS patients by the year 2000 is about 562,000.
The infection rate is very high and tends to increase the public health problem in Thailand.
Geographically the problem is severe in the northern part of the country where there are more
cases in proportion to the capital city. More than half of the new cases occur in the under 25 years
population and the Asian economic crisis is likely to increase the HIV burden borne by the
younger population. The Asian economic crisis has exacerbated the AIDS problem in Thailand.
In Thailand AIDS is a Regional epidemic as in the rest of the Asia. This is due to the
development of HIV diseases at different stages at different places. The long latency period of the
disease makes it easy to predict that this will be a huge problem. Since, 1989 an explosive
epidemic of HIV-1 has occurred among commercial sex workers in a semi-rural areas of
Northern Thailand (Chiang Mai). The HIV-1 incidence estimate the highest rate of sexual
transmission by the commercial sex workers. Due to poverty and under nutrition the government,
political leaders, religious leaders and community leaders of developing countries have often
overlooked the significance of AIDS. The long latency period of the virus to cause infection is
one of the important reasons of transmission. Thailand was in deep denial about its AIDS
problem when new of the epidemic began to surface. The government of Thailand is fearing that
negative publicity will hurt the nations largest source of foreign capital i.e. tourism. Prostitution
is one of the top monetary contributor to Thailand’s GDP. Virus is spreading rapidly in and
around the area known as ‘Golden Triangle’, the meeting point of Lao People’s Democratic
Republic, Myanmar and Thailand where most of the worlds opium and heroin are produced. The
recent global HIV/AIDS epidemic report of June 2000 of Thailand is shown in Table 2.
Table 2. Global HIV/AIDS epidemic report of Thailand – June 2000
Description
People living
with HIV/AIDS
AIDS orphans
Total adult and
children
755,000
Adult 15-49
years
740,000
Women 15-49
years
305,000
Children <15
years
13,900
75,000
-
-
-
66,000
-
-
-
AIDS death
7. AIDS distribution in Thailand
For the duration from September 1984 to April 2000 Thailand faced the spreading of HIV
infection problem and AIDS patient problem which impact Thai population strongly and
continuously. However, the number of patients that is reported may be less than 30% of the real
numbers. The year wise distribution of AIDS cases in Thailand is shown in Table 3.
Table 3. Year wise distribution of AIDS cases in Thailand from September 1984 to April 2000.
Description
Number of
AIDS cases
Year
1984-85
1996
1997
1998
1999
43,665
24,201
26,164
25,691
20,416
April
2000
1890
Total
number of
AIDS case
142,027
Total
death
39,193
8. Age and sex-wise AIDS distribution
In Thailand in the year 1998 the HIV/AIDS patients are screened on the basis of the age and sex
and the following information are obtained. The age and sex-wise patients distribution is shown
in Table 4.
Sex-wise distribution – approx. male and female ratio is 4:1.
Age wise distribution – below 20 years male and female ratio is 1:1.
- above 20 years male and female ratio is 4:1
Table 4. Age and sex-wise distribution of AIDS patients in Thailand in the year 1998
Description
Number of male
patients
Number of
female patients
Age group (years)
20-29
30-39
40-49
0-4
5-9
10-19
318
55
60
4185
5403
277
68
63
1973
1203
50-59
60+
1553
333
182
365
91
23
9. Mode of HIV transmission in Thailand
9.1. Heterosexual transmission is 82.6%. Among these percentage about 97-98% of HIV
transmitted by the commercial sex workers and the remaining is transmitted by the normal
heterosexual relations among non commercial partners, e,g, girlfriend, boyfriend, wife-husband.
Among men who visited prostitutes about 75% are Thais and 20% are foreign men visiting
Thailand. 87% of the women and children in prostitution in the north of Thailand in Chiang Mai
and Chiang Rai are HIV positive. This is because the women of north Thailand are very beautiful
because of their mixed heritage – Thai Laotian, Cambodian, Burmese, Chinese. They are
recruited into the sex trade as men find these women desirable. The aggressive advertising
campaign by the ‘Condom King’ got the word to the Thai speaking people that commercial sex
workers will die if they do not use condoms. This caused the sex industry to become undesirable.
As a result people recruit sex workers from northern hilly and border areas as well as from
villages. These women do not speak Thai as they are illiterate and can not understand the
warnings given by the government in Thai language and as result they became infected with HIV.
Young adolescent girl prostitutes are at great biological risk of HIV infection, as they have to
meet with elderly clients who have history of several exposures. The remaining portion which is
transmitted by the normal heterosexual relations among non-commercial partners are due to lack
of faithfulness of the partners. For married women it has become high risk behaviour to have
unprotected sex with their husbands, unless they are absolutely certain that their husbands are not
visiting sex industry.
9.2. Intravenous drug users is 5.3% of the HIV infected population. The Thai Ministry of Public
Health has found that 30-40% of drug users have HIV. The AIDS epidemic in Thailand gained an
early foothold among intravenous drug users. People who inject drugs tend to be associated with
poverty and crime. Needles and syringes are expensive so, many people improvise intravenous
equipment, which they then share with others, due to poverty.
9.3. From mother to child transmission is 5.03%. High prevalence of HIV is found among
pregnant Thai women attending pre-natal clinic for examination. Transmission of HIV from
mother to child occurs during pregnancy, delivery and through breast feeding. One half of the
transmission occurs during breast-feeding.
9.4. Through blood transfusion the disease transmitted to 0.05%.
9.5. The other unknown causes of transmission is 7.02%.
9.6. Homosexual transmission virtually non existent
10. Cofactors for disease progression
Endogenous biologic or psychologic factors, other infections, behaviours, or other environmental
factors that alter the natural history of HIV infection may be cofactors for disease progression.
They include genetic factor, age, sex, route of HIV infection, other infection, poverty, nutrition,
smoking, descrimation, sexual inequality, inadequate health and social services, rapid
urbanization, inappropriate development and increase labour migration.
Increased labour migration is an important factor in the spreading of HIV. Since mobility of the
labour is a primary cause of changing behaviour and seeking new partners for sexual activity.
Economic development stimulated population movement. As they leave in search of livelihood
elsewhere they are exposed to a new socio-economic environment. Working in a foreign land
does not allow access to information on HIV/AIDS and reduce the quality of health services due
to language barrier. The risk of HIV also dramatically increases with disaster, war, political and
economic crisis.
11. HIV prevention measures
HIV prevention programme should be a multidisciplinary approach combining behavioural
science, social science and biological methods to fight against the spread of HIV.
The goal of our fight against HIV is to benefit people affected by or at risk of HIV/AIDS, so that
they receive better care, greater respect and more integration in the society. Moreover it should
create and promote an enlightened medical view on HIV/AIDS.
The following general measures can be taken for the prevention of HIV infection and as well as
AIDS:
i)
A health policy relating to HIV/AIDS prevention should be developed
ii)
Education – medical education including responsibility and regular advice for the health
professional. Promotion of education to the policy makers about ethical, social policy and
human rights of HIV/AIDS. Health education regarding safe sex, HIV prevention and
sexual health promotion to the public and continuing debating on the ethical issue of HIV.
iii)
Health development has to be adopted to economic, political and social change
iv)
Health legislation that reflects the principles of social, medical, ethics and human rights
v)
Broad social policy.
Integrated approach for HIV/AIDS prevention with care is of great value. Integration of all
service in the health sector and other sectors such as business, tourism, the armed forces,
education, religious organization, developmental agencies and mass media – to create a more
favourable environment for HIV risk reduction strategies and measures that bring about social,
cultural and economic changes.
Active community participation of different community organizations and social movements can
change the attitudes and practices of the people regarding risky sexual behaviour and injectable
drug use.
High level political commitment for prevention of HIV is of value. In the early 1989 the Thai
government acknowledged the spreading epidemic and instituted a wide spread initiative of
AIDS education and prevention. Mr. Mechai ViraVaidya the ‘condom king’, a government
minister who initiated a radio and television campaign warning against the danger of HIV/AIDS.
He popularised the use of condoms, which slowed the acceleration of the spread of HIV
infection. A nation wide 100% condom programme has encouraged commercial sex workers to
use condoms free of cost. Condom use among commercial sex workers has increased to about
90% and resulted in a sharp decrease in STD including HIV.
Prevention of sexual transmission of HIV
Prevention of new HIV infections involves changing people’s behaviour related to sex, drug use
and medical practice.
i)
ii)
iii)
iv)
v)
vi)
100% use of condom during sexual activity. Condoms are classified as medical device
and are regulated by the FDA. Use of condom while engaging in sexual intercourse vaginal, anal or oral can greatly reduce a person’s risk to HIV.
Changing people’s behaviour related to sex by comprehensive and early sex education
and by training in prevention skill, safer sex etc., can reduce the risk of HIV transmission.
Successful behavioural strategies as well as cutting edge bio-medical technologies are
necessary to cut the spread of HIV. Behavioural strategies have cut infection rates by 50%
in developing countries.
Providing confidential voluntary counselling and testing of HIV
Illegal commercial sex worker (CSW) industry should be stopped and rehabilitation of
CSW is needed for prevention. Since CSW industry is so widespread in Asia may be we
could try to rehabilitate CSW and also localised prostitution so that we can provide CSW
with health care, give them free condom etc.
Providing monetary incentives to the girls to complete secondary education
Provision of comprehensive service delivery and medical care for STD by the medical
and paramedical professional and community workers. Community workers should reach
out and deliver basic services including condoms and STD treatment and cover the whole
range of the community talking with men and women.
Prevention of IDU
Needle exchange programme has cut HIV transmission among IV drug users. Treatment and
rehabilitation centres for IV drug users play an important role in HIV prevention and drug users
come back to their normal life.
Prevention of HIV through blood transfusion by blood-screening technology can able to prevent
transmission of HIV 99%.
Prevention of transmission from mother to child can be prevented if both father and mother get
tested for HIV before pregnancy. If the results are positive and the pregnancy is desirable then by
using anti-retroviral regimen (AZT) the transmission can be cut down during pre-natal period.
World Health Organization (WHO) view regarding prevention measures is almost similar to that
described above.
View of BMA (British Medical Association) foundation for AIDS
Principle- The foundation believes that the experience gained through HIV and AIDS should be
incorporated into wider professional learning and understanding. Approaches to HIV/AIDS
should be based in medical science, clinical and public health experience.
Strategy – BMA is taking a leadership role in creating and promoting consensus on the planning
and the provision of national health services.
United Nations Development Programme (UNDP) - HIV and Development in Asia
It aims to reduce vulnerability through development and to prevent HIV risk linked to
development by integrating poverty alleviation, good governance, gender and rights. The project
focuses on the following points to prevent HIV risk in relation to socio-economic development
through:
i)
Capacity building with government and non-government and local community to reduce
HIV risk
ii)
Social mobilisation to promote resilience to HIV by engaging communities and other
sectors
iii)
Institutional partnership building between health and education sectors
iv)
Advocacy and information dissemination
12. Conclusion
Prevention is better than cure.
The drugs, which are used in the treatment of AIDS have no curative value rather than
suppression of the disease and are not able to prevent transmission of viruses.
Prevention methods coupled with unsqueamish public awareness campaigns to make those
methods widely known and adopted can start to turn the tide and check the inexorable spread of
this insidious disease.